Professional Documents
Culture Documents
This planning guide provides a range of ideas, information and tools for developing a comprehensive plan for creating a healthy, active city by enhancing physical activity in the urban environment. By developing, improving and supporting opportunities in the built and social environments, city leaders and their partners can enable all citizens to be physically active in day-to-day life. Keywords
URBAN HEALTH CITIES HEALTH PROMOTION MOTOR ACTIVITY EXERCISE PHYSICAL FITNESS HEALTH POLICY LOCAL GOVERNMENT
Contents
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi Part 1. A healthy, active city 1. Introduction . . . . . . . . . . . . . . . . . . . . Purpose of this guide . . . . . . . . . . . . . . . . . . Building on other key publications . . . . . . . . . . . . Moving about: what should this be called? . . . . . . . . The healthy city approach . . . . . . . . . . . . . . . . Why is a plan needed for physical activity? . . . . . . . . Relationship to other planning processes in a healthy city. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1 1 2 3 4 5
2. A comprehensive approach to active living in the city . . . . . . . . . . . . . . . . . . 6 A framework for creating a healthy, active city . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 A three-stage planning process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 3. Who does what? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Partners for active living Public sector . . . . . Civil society . . . . . . Private sector . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 10 11 12
Part 2. Creating and implementing a physical activity plan 4. Stage 1: getting started . . . . . . . . . . . . . . . . Build commitment. . . . . . . . . . . . . . . . . . . . . . . Form a leadership group . . . . . . . . . . . . . . . . . . . Create a vision . . . . . . . . . . . . . . . . . . . . . . . . Profile your city, neighbourhoods and target population groups Consult with residents and stakeholders . . . . . . . . . . . . Identify opportunities and constraints . . . . . . . . . . . . . Strengths. . . . . . . . . . . . . . . . . . . . . . . . . . Weaknesses . . . . . . . . . . . . . . . . . . . . . . . . Opportunities . . . . . . . . . . . . . . . . . . . . . . . Threats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 16 16 18 19 20 22 22 22 23 23
Identify funds and resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Set goals and objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 5. Stage 2: preparing a plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Develop key interventions. . . . . . . . . . . . . . . . . . . Policies. . . . . . . . . . . . . . . . . . . . . . . . . . . Programmes . . . . . . . . . . . . . . . . . . . . . . . . Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . Infrastructure strategy . . . . . . . . . . . . . . . . . . . Communication . . . . . . . . . . . . . . . . . . . . . . Set priorities for intervention options in the built environment . Action strategies in urban planning . . . . . . . . . . . . . Action strategies in active transport and public transport . . Action strategies in urban design . . . . . . . . . . . . . . Action strategies in communication . . . . . . . . . . . . . Set priorities for intervention options in the social environment Action strategies in diversity and equity . . . . . . . . . . . Action strategies in social cohesion, safety and social support Set priorities for intervention options in specific settings . . . . Active schools . . . . . . . . . . . . . . . . . . . . . . . Action strategies in schools . . . . . . . . . . . . . . . Active workplaces . . . . . . . . . . . . . . . . . . . . . Action strategies in workplaces . . . . . . . . . . . . . Active neighbourhoods. . . . . . . . . . . . . . . . . . . Action strategies in neighbourhoods. . . . . . . . . . . Leisure and sport settings . . . . . . . . . . . . . . . . . Action strategies in leisure and sport settings . . . . . . Health care settings . . . . . . . . . . . . . . . . . . . . Action strategies in health care settings . . . . . . . . . Strengthen individual intentions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 28 28 29 29 29 30 30 30 31 31 32 32 33 33 33 34 35 35 36 36 36 37 37 37 38
6. Stage 3: implementing the plan and measuring success . . . . . . . . . . . . . . . . 41 Stage implementation . . . . Evaluate your progress . . . Share your results . . . . . . Review and update your plan Part 3. Resources 7. Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Tool 1. Identifying potential partners for a physical activity task force or leadership group . Tool 2. Opportunities for physical activity: a community assessment tool . . . . . . . . . Tool 3. A sample walkability audit . . . . . . . . . . . . . . . . . . . . . . . . . . . . Tool 4. How cycling-friendly is your city?. . . . . . . . . . . . . . . . . . . . . . . . . Tool 5. How well are our schools doing? A sample report card for physical activity . . . . Tool 6. Special events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . European and international events promoting physical activity. . . . . . . . . . . . . Tool 7. A checklist for identifying activities with which to proceed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 46 49 50 54 56 57 59 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 42 44 44
8. Learning from others: examples from cities in Europe . . . . . . . . . . . . . . . . . 60 9. Key sources for further information . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Web sites with multiple resources and links Selected publications . . . . . . . . . . . Examples of comprehensive city plans . Planning for physical activity . . . . . . Active transport . . . . . . . . . . . . Special populations and settings . . . . Physical activity and health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 73 73 73 74 75 76
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Acknowledgements
We would like to express our gratitude to the cities of the WHO European Healthy Cities Network who reviewed and commented on the text during several consultation rounds. A special word of thanks is due to Marie Louise Bistrup and to Lideke Middelbeek, Technical Officers at the WHO Regional Office for Europe, who provided valuable technical, editorial and coordination input. Many thanks go to Connie Petersen for efficient administration of all stages of the production of this publication and to David Breuer for meticulous text editing. The information in this publication is informed by many resources (listed in Chapter 9) and especially by Community physical activity planning: a resource manual. Toronto, Ministry of Health Promotion, Ontario, 2006 (www.mhp.gov.on.ca/english/sportandrec/PlanningResrceManual_FINAL.pdf). Peggy Edwards and Agis D. Tsouros
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1. Introduction
Improving participation in health-enhancing physical activity is a public health issue of urgent concern. It is also about the well-being of communities, protection of the environment and investments in future generations.
A healthy city is an active city: a physical activity planning guide Promoting physical activity and active living in urban environments: the role of local governments. The solid facts (1) provides a concise overview of the best available evidence on physical activity in the urban environment (including references) and makes suggestions for policy and practice based on that evidence. Physical activity and health in Europe: evidence for action (2) sets out the facts about health-enhancing physical activity, provides examples of approaches already being taken, highlights the contributions that can be made by health systems and other sectors and makes the case for concerted action across the European Region. It contains a complete set of references.
Introduction
Box 2. Some key findings from an analysis of active living in cities in the WHO European Healthy Cities Network Most member cities viewed active living as an important issue for urban planning, such as improving visual appeal, enhancing social cohesion, creating a more sustainable transport system and reducing inequality in public health. Most member cities reported action initiated to promote active living, with an emphasis on actions targeting the built and social environment to promote walking and cycling. Many efforts to promote active living are nested in programmes to prevent obesity among adults and children. Only eight cities mentioned an integrated framework specific for active living. The health care sector was clearly involved in 25 actions, predominantly as an arena to identify and reach sedentary individuals and to initiate disease prevention programmes. Frequently mentioned barriers to promoting active living included lack of funding and lack of commitment from decision-makers. Better evaluation methods are needed to improve the evidence base on which actions are effective to promote different types of active living among different groups, since evaluation strategies appeared to be insufficient. Future challenges include establishing integrated policy specific for active living, introducing a larger range of actions and increasing funding and capacity to make a difference at the population level.
Source: Faskunger JT. Active living in healthy cities. Journal of Urban Health (in press).
Introduction have less air and noise pollution and better access to green spaces; enhance neighbourhood revitalization, social cohesion and community identity; and expand social networks. Physical activity and health in Europe: evidence for action (2) provides more information on physical activity, sedentary living and health. Promoting physical activity and active living in urban environments: the role of local governments. The solid facts (1) provides more information on the benefits of investing in active living in the urban environment.
Settings Schools Workplaces Health care Leisure-time and sport settings Neighbourhoods
Population groups All residents Children and youth Older people People with disabilities People and neighbourhoods with low socioeconomic status Other minority and high-risk groups
Local government Elected officials, urban planners, sport and recreation, health, transport, education, law enforcement, tourism
Employees
Community participation Interventions Long term Policies Programmes Short term Plans Infrastructure strategies Communication
Box 4. Key influences on physical activity in the built and social environments People walk and cycle more when destinations such as shops and schools are close by and are connected by pedestrian-friendly streets (10,11). Policies that improve walkability and mixed land use also increase community cohesion and perceptions of personal security (10). Traffic-calming measures and policy changes at the local level increase pedestrian and bicycle travel (12). Disadvantaged populations are less likely to have easy access to the places that encourage a healthy lifestyle, such as safe streets and sidewalks, playgrounds, parks, trails and community gardens (13). Even high-income countries have steep social class gradients in pedestrian injury rates, and the relationship between lower social class and more injuries among child pedestrians is well established (14). Participation in physical activity differs by sex. Across all countries and regions in Europe, girls are less active than boys and the gender gap increases with age (3). Social support interventions in community settings (such as neighbourhoods, workplaces and universities) can result in a 44% increase in the duration of time spent being physically active and a 20% increase in the frequency of physical activity (15). Promoting physical activity and active living in urban environments: the role of local governments. The solid facts (1) summarizes the research on factors in the built and social environments that influence physical activity and findings related to specific population groups and settings.
A comprehensive approach to active living in the city This planning process is a general guide that describes important tasks in a logical sequence. However, you may wish to adapt the process to better suit your circumstances and to dovetail with other planning processes in your city. Box 5. A three-stage planning process Stage 1. Getting started 1. 2. 3. 4. 5. 6. 7. 8. Build commitment Form a leadership group Create a vision Profile the city, neighbourhoods and target population groups Consult with residents and stakeholders Identify opportunities and constraints Identify funds and resources Set goals and objectives
Stage 2. Preparing a plan 1. Develop key interventions Policies Programmes Plans Infrastructure strategy Communication 2. Set priorities for intervention options in the built environment 3. Set priorities for intervention options in the social environment 4. Set priorities for intervention options in specific settings 5. Strengthen individual intentions Stage 3. Implementing the plan and measuring success 1. 2. 3. 4. Stage implementation Evaluate your progress Share your results Review and update your plan
Source: adapted from Community physical activity planning: a resource manual (16).
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Public sector
Elected officials need to take a leadership role in developing and championing an active living strategy, not only with the public but also with their colleagues. Everyday decisions related to priorities in funding, urban design, recreation, transport and regeneration priorities all influence peoples activity levels and ultimately their health and well-being. Municipal sport and/or recreation services usually manage city programmes related to physical activity, parks, playgrounds and facilities such as swimming pools, playing fields, arenas and community centres. In some cities, public health departments lead community efforts to increase physical activity for special populations and in certain settings in partnership with communities, schools, local businesses and health care facilities. As large employers, hospitals can lead by providing employees with opportunities for exercise and active transport. Long-term care residences and seniors homes have a key role (that is often overlooked) in encouraging active living among older people. Primary care physicians and nurses are in an ideal position to counsel on physical activity and refer people to community programmes and facilities. Municipal transport planners and staff are key to developing and maintaining opportunities for active transport (walking and cycling), discouraging car use and improving road safety. Officials involved in regional and national transport issues (such as intercity trails, national programmes to support public transport and clean air) can also provide resources and technical support for active transport strategies.
Who does what? Urban planners have a leadership role to play in designing and maintaining the built environment in ways that promote active living. Urban planners become effective champions of active living when they consider enhanced physical activity as a worthwhile goal in plans to enhance the physical and social environments and act as catalysts in discussing options among broad groups of stakeholders. Schools (from child care to university) are key settings for physical activity (see Chapter 5), and educators are key in advocating the benefits of active living, counselling on an active lifestyle and teaching skills. Researchers in a university or college can develop pilot projects and evaluations of communitybased initiatives in collaboration with residents and sponsor programmes for special groups. Municipal police forces are important partners both in promoting road safety and preventing crime. For example, community police can help establish safe and active routes to school and are responsible for keeping parks safe from crime and vandalism. Government officials and business leaders who promote tourism can be important actors in a physical activity planning process. People like to visit cities that are walkable, attractive, sociable and activity-friendly. Municipal carnivals and special events that feature physical activity attract tourists and bring substantial resources to the city. Holiday destinations on the periphery of the city such as ski hills and national parks are also important to tourism.
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Civil society
An urban active living strategy mainly focuses on sport for all. This movement, which emphasizes participation and developing skills, is well organized in all European countries and has a rich history of public participation at the local level. In keeping with the International Charter of Physical Education and Sport and the Council of Europe Charter, proponents of sport for all believe that the practice of physical education and sport is a fundamental right and essential element in lifelong education for every citizen. In recent years, sport organizations have broadened their mandate beyond competitive sport to include various forms of everyday physical activity in a variety of settings. Volunteer leaders and coaches in sport tend to hold leadership positions in their communities and can serve as key advocates and mentors for active living in the city. Some specific organizations such as cycling and gymnastics and those representing disabled sport participants can be very effective at encouraging and enabling policy and infrastructure changes that support physical activity for all. Elite sporting events (such as national games and the Olympics) provide opportunities to build spirit, but city hosts need to carefully consider how elite facilities can be effectively used later for active living for ordinary citizens.
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A healthy city is an active city: a physical activity planning guide Cultural organizations can enrich a plan for active living by providing input and opportunities for active participation in dance and other forms of traditional physical activity. This may be an effective way to engage minority populations and build social networks. Many voluntary health and patient organizations provide information, programmes, leadership and support for active living. They often sponsor popular events such as walks or runs for diseases such as heart disease, diabetes and cancer. Voluntary groups working in nature and the environment are natural allies for developing and implementing plans and programmes related to green spaces, parks, woodlands, rivers and waterfronts. Representatives from resident committees (especially in low-income neighbourhoods), services and organizations dedicated to children and youth, ethnic groups, older people and people with disabilities provide a voice for these population groups. Representation of people with disabilities (both physical and mental) may be particularly important since they are often overlooked in plans to enhance physical activity. Informal groups often form in neighbourhoods: for example, a walking group for young mothers and their babies or weekly pick-up games at a local school, church, mosque or synagogue.
Private sector
Employers can support and sponsor programmes, policies and services that encourage active living among their employees and families (see Chapter 5). Most workplace programmes for physical activity are initiated by employees or are jointly developed by employees and employers (Boxes 6 and 7). Fitness clubs and schools of dance are in the business of physical activity. They promote physical activity and will often partner in or lead special events. Private businesses can provide funds, equipment and/or expertise for special events, building projects, facility and trail construction. Business leaders who are well respected in the community can serve as personal ambassadors for active living. Mass media (such as radio, television, print and the Internet) are important partners for creating awareness and disseminating physical activity messages, campaigns and events. Physical activity and health in Europe: evidence for action (2) provides more information on the roles of various stakeholders in promoting active living.
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Box 6. Partners in physical activity planning: the public sector, civil society and the voluntary sector and the private sector Public sector Elected officials Sport and recreation Health Transport Urban planning Education Law enforcement Tourism Civil society and the voluntary sector Voluntary organizations in sport, culture, nature and health Representatives of residents and special groups Informal groups Private sector Employers Employees Fitness clubs and dance schools Corporate sponsors Mass media
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Box 7. The social and economic benefits of sport and physical activity The provision of recreation and sport activities for children, as part of a package to help solesupport parents on social assistance, can contribute to moving more families off social assistance (17). Involvement in sport and physical activity can result in greater community ownership and care of local facilities and resources and can build capacity, skills and confidence in communities, enabling them to tackle wider community issues (18). A United States study showed that physically active people have lower annual direct health care costs than inactive people and that increasing regular moderate physical activity among inactive adults might reduce the annual national direct health care costs by many billions of dollars (19). Employers also benefit, since having a physically active workforce can lead to reductions in absenteeism and increased productivity (20). Sport can be useful in reducing crime and antisocial behaviour if programmes are designed to address specific factors (21). Medium- or high-density towns and cities in which trips are already being made mainly using public transport, walking and cycling spend the least on providing transport for their inhabitants (22). The economic benefits of hosting major sporting events such as the Olympics have been shown to be negligible, but political, development and sociocultural benefits can occur (23). Events such as marathon running and cycling attract participants and tourists and increase the prestige and recognition of the host city. Cities can also devise urban regeneration strategies around sporting events. For example, development for the 2012 Olympics will centre in Stratford, Borough of Newham, East London one of the capitals most diverse and economically deprived areas. The redevelopment of brownfield sites and a transport hub will significantly improve the face of this neighbourhood (24).
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Proverb
Stage 1 Getting started 1. Build commitment 2. Form a leadership group 3. Create a vision 4. Profile the city, neighbourhoods and target population groups 5. Consult with residents and stakeholders 6. Identify opportunities and constraints 7. Identify funds and resources 8. Set goals and objectives
This chapter describes eight steps in stage 1 for preparing a physical activity plan.
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Build commitment
The healthy city approach suggests that success requires explicit political commitment at the highest level. Mayors, elected officials and senior city staff can provide the political legitimacy and technical support that is needed to integrate urban planning and public health policies in a way that supports active living for all citizens. In several European cities, mayors champion active living through personal example (such as cycling to work or meetings), high-profile communication (such as building city pride and identity about active living initiatives at a variety of public events) and specific support through assigned long-term budgets and resources for special initiatives and community-based projects. City governments can also lead by example. For example, local government can provide fitness facilities and/or programmes for city employees and their families; locate city facilities and offices in settings that deter car dependence and encourage the use of active transport; and support on-thejob cycling by city employees in policing, traffic control, etc. A coordinated plan for active living, sport and physical activity requires a commitment to action in the public sector, civil society and the voluntary and private sectors. To build this commitment, schedule one-on-one and group meetings with key leaders in all sectors. Be prepared to demonstrate the problem and to sell the benefits of an active city in a win-win way. For example, show education and transport officials how support for active transport (walking and cycling) serves both their goals and yours. Listen well to leaders in sport-for-all, cultural and environmental organizations to find ways to collaborate and to build their enthusiasm for a coordinated approach. Provide employers with statistics on the cost savings associated with an active, productive workforce. This stage is not always easy. It helps to recruit champions for active living, such as athletes, entertainers and leaders in business and religious, educational and voluntary communities. These people serve as important role models for active living and attract others to participate.
Stage 1: getting started At the same time, a clear manager or coordinator should be appointed for the day-to-day activities and overall progress. Some cities assign the government department responsible for sport and recreation or health promotion to the coordinating and management function; others are led by nongovernmental organizations in sport, active living or disease prevention or by the healthy city office. Whoever takes on the coordinating role needs to be supported with financial resources, expertise and voluntary help with communication. Depending on the scope of the plan, additional committees or working groups with different functions and areas of concentration may be needed. Group members usually include volunteers from the community and staff recruited from city government and community agencies and groups.
17
Health sector
Transport
Sport
Urban planning
Business sector
Residents committee
Education
Tourism
University
Elected officials
Senior groups
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Create a vision
A plan for active living should start with a sense of where you want to go and towards what you want to work. Creating this shared vision for the future is the first task of your leadership group, in consultation with community residents and stakeholder groups. Creating a vision begins with a group of diverse people who share interests in a project, resource or community. They are asked to state what they value about physical activity in their neighbourhood or city and what they would like to see improved in the next 510 years. The final vision can be any length a single sentence or a few bullet points as long as it is clear, focused and easily understood. Creating a vision is the first step in planning for the future. Visioning involves describing what you want to see in the future, creating a picture of your ideal or preferred future as though you were seeing it right now. There are several techniques for creating a vision (Box 8). Most visions of a healthy, active city share some common factors or themes: a wide range of accessible and attractive routes for active transport such as cycling and walking and access by foot or bicycle to efficient public transport; mixed-use, high-density communities with easy access to destinations such as shops, parks, schools and recreation facilities; walkable, attractive neighbourhoods and trail connections between neighbourhoods; planning decisions related to the built environment consider public health and physical activity concerns; schools, workplaces and health care facilities support active living choices; ample green and open spaces for physical activity, sport and enjoying nature; accessible facilities and equipment for physical activity; streets and neighbourhoods that are safe in terms of road safety and crime; programming and services for special groups that enable active living for all ages and abilities; champions in local government and other sectors; strong involvement by a variety of stakeholders and citizens; and social norms and expectations that support and encourage active living as a way of life in the city.
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Box 8. Ideas for creating a shared vision for active living 1. Look into the future It is 10 years from now and our city has just won a national award for being a healthy, active city that enables all its citizens to be physically active on a daily basis. Imagine you are in a hot-air balloon floating over our city 15 years from today. Our city is known to be an ideal place for active living by all. 2. Describe what you see. Observe the total scene people, places and happenings. Cruise down streets and visit parks, workplaces, health care facilities and schools. Check out modes of transport and city council meetings. Listen to what the mass media are covering. Observe what older people and people with disabilities are doing. Smell the air, plants and green spaces; listen for laughter and road traffic noises. Draw what you see or write it down in short descriptive sentences. 3. Look backwards. If this were the future, and this vision has happened, what was done? How did we get this outcome?
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A healthy city is an active city: a physical activity planning guide Healthy, active cities also need to plan for different life stages and to understand the attitudes, beliefs, needs and strengths of special groups including children and young people, older people, girls and women, people with disabilities, minority groups and people with low socioeconomic status. The first step is to clarify the communities in the city in which these populations live, study, worship, move and work. Clearly defining and understanding the target populations you wish to reach is essential to good planning. For example, while creating a pedestrian or cycling path in a particular neighbourhood may seem to benefit all the residents, older people may not use it if it is designed for fast cycling and has no separate areas for walking. Similarly, girls and women are less likely to go to a recreation facility that is not well lit and in an unsafe setting. Young people are more likely to spend time in a place that encourages interaction, for example by combining basketball and tennis courts with a skateboarding area and a meeting place with picnic tables and bicycle parking.
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Box 9. Information to consider when profiling target populations and neighbourhoods Demographics: age, sex, race and ethnicity, marital status, presence of children in the home Socioeconomic status: income status, social status, education level, housing status, employment status and occupation level, social exclusion and inclusion Geographical information: clustered or scattered, characteristics of neighbourhoods: what places are shared: schools, workplaces, shops, community health centres places of worship, etc.? Current behaviours and lifestyle: how physically active are they? What competes with being physically active? What kinds of activities do they like to do? What are their current modes of transport? Awareness and knowledge: how much do they know about the benefits of physical activity and the risks associated with sedentary living? Values, beliefs and attitudes: how important is a healthy, active lifestyle to them? Do they view physical activity as valuable and important? What do they perceive are the major barriers to being active? How ready are they to change (that is, become more physically active)? What would make physical activity more fun and attractive to them? Health, ability and confidence levels: do they have health conditions that limit their ability to participate? Do they have the skills they need to be physically active? How confident are they in their ability to be active? Cultural norms and social networks: do cultural customs, beliefs and traditions hinder or support participation by women, men and children? Who would support them in being physically active? Who is in their key informal networks? To what organizations do they belong? Access and use: are existing sport and physical programmes, natural resources (such as trails and rivers), activity facilities (such as playing fields, playgrounds and schools) and options for active transport available, accessible and affordable to this population? Do they make use of these? If no, why not?
the neighbourhood level; and small meetings with people who are socially excluded and tend to be underrepresented at open community consultations. There are many techniques for conducting consultations, including stakeholder meetings, public forums, workshops, focus groups, key informant interviews and charrettes (Box 10).
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Box 10. What is a charrette? Charrettes bring together experts and local residents to develop ideas on how to improve the built environment (such as making it more conducive to active living). Solutions are usually presented as maps, diagrams or descriptions. Charrettes can involve a few or many people; they can last a couple of hours or extend over several days. It all depends on the purpose of the charrette and peoples interest. An example of a charrette schedule is participants gathering on a Friday, touring the area and hearing presentations from local experts and citizens. On Saturday, participants are divided into teams and asked to create plans, drawings, and descriptions of proposed changes to the built and social environments. Later that night, or the next day, participants present their recommendations to each other and community members. This is followed by debate and consensus-building with the help of a professional facilitator. Charrette means cart in French. In the early 20th century, professors from the Ecole des Beaux Arts in Paris would send a cart to pick up students work at the submission deadline. Some students, frantic to complete their drawings, would ride on the cart and continue working as it rolled down the street, hence, working en charrette.
Strengths
Proximity to seashore Revitalization project underway in inner city Effective public transport infrastructure Motivated partners in education, sport and day nurseries Committed leadership in mayor and health sectors Two universities with degree programmes in kinesiology and health promotion Public support for building a multipurpose cultural park at the waterfront
Weaknesses
The waterfront is run down and unattractive Poor public transport to the waterfront Crowded inner city, with little space for parks and greenery
Stage 1: getting started Parking prohibits the development of potential green spaces Heavy road traffic in the inner city unsafe for cyclists and pedestrians Limited support for active transport Few opportunities for active play by children and young people in the inner city Poor communication about opportunities for active living: families unaware of what is available Young people in the inner city getting into trouble, with vandalism and graffiti
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Opportunities
Develop pocket parks connected with pedestrian trails and play areas as part of inner-city regeneration Build cycling lanes (tracks) as part of road repair in the inner city Provide parking for bicycles at public transport stations Involve the cycling association Invite the mayor to champion active living through active transport Invite city councillors to champion active play for children and work with day nurseries and schools, parents and the city recreation department to provide safe, interesting play areas and active safe routes to school Replace some above-ground parking with underground parking and create green spaces in these areas Charge higher parking fees and implement an inner-city congestion charge Work with partners to improve communication about active living: benefits and opportunities Work with the universities, police and social services in selected neighbourhoods to introduce and evaluate youth-driven physical activity and sport programmes Build support for a long-term project to reclaim waterfront and build parklands there for active living and cultural activities
Threats
Perceptions that initiatives will cost too much Driver backlash against parking restrictions, higher fees and a congestion charge Developers unaware of the economic value of including trails and playgrounds in areas that are being rebuilt Fears and perceived fears related to road safety Multiple languages and low literacy levels in some neighbourhoods (need for innovative means of communication)
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A healthy city is an active city: a physical activity planning guide Objectives are measurable statements that can be used to determine whether a goal has been met. Objective setting is linked to evaluation: if you are to evaluate your progress you must gather baseline measurements at the beginning of the initiative and not wait until the end. Here are four steps for identifying the objectives that you want to achieve, with a specific example related to active transport to and from school. 1. Describe the situation you want to change or the problem you want to solve.
Example
Most children are driven to school. In addition to distance, parents cite concerns about safety as the main barrier to walking and cycling to school. 2. Identify the specific actions you want people to take to help solve the problem.
Example
Raise awareness of the problem and the benefits of active transport to and from school Create school, parent and community partnerships for solving the problem Identify and create safe, active routes to school (local level) Provide tools and support to help communities and schools implement active safe routes to school Accompany young children to school by walking or cycling (such as a walking school bus) Encourage and support children and young people to walk and/or cycle to and from school 3. Set measurable objectives that can help you monitor and evaluate your progress.
Example
During the school year (10 months): increase the number of community politicians, police and traffic officials, students, parent school association members, principals and teachers who are aware of the problem and willing to take action; develop school, parent and community partnerships for active safe routes to school, initially in two school districts (10 schools);
Stage 1: getting started implement walking and cycling school bus programmes, initially in two school districts (10 schools); and increase the number of children and young people who safely walk and/or cycle to and from school. 4. Decide how you will measure the achievement of these objectives.
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Example
In designated school districts: baseline measures of current awareness, concern and intention to act follow-up surveys midway and at the end of the school year; the number of school, parent and community partnerships for active safe routes to school formed and active (baseline and follow-up); the number of walking and cycling school bus programmes (baseline and follow-up); the number of road crashes involving students (baseline and follow-up); the number of children and young people who walk and/or cycle to and from school (baseline and follow-up); the prevalence of school policies related to driving children to school and safety for pedestrians and cyclists (baseline and follow-up); the prevalence of safe and secure bicycle parking at schools (baseline and follow-up); the number of children and young people who walk and/or cycle to and from school (baseline and follow-up); and the satisfaction of students, parents, principals and teachers with active, safe routes to school programmes and policies.
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Jacobs (25) Stage 2 Preparing a plan 1. Develop key interventions Policies Programmes Plans Infrastructure strategy Communication 2. Set priorities for intervention options in the built environment 3. Set priorities for intervention options in the social environment 4. Set priorities for intervention options in specific settings 5. Strengthen individual intentions This chapter provides information on key interventions, with examples in the built and social environments and in specific settings, and ideas on how to strengthen individual intentions to be active. Part 3 provides sample programmes and explains where to get further information on the ideas suggested here.
Policies
Policies set direction for the course of action on many fronts. Ideally, local governments will adopt an overall policy to consider the promotion of physical activity as an integral part of all decision-making and then apply it when making decisions related to funding, programmes, urban planning and infrastructure development. Similarly, workplace and school policies can remove barriers and encourage physical activity.
Programmes
Programmes are schedules of new or changed activities to increase levels of physical activity for the general population and for targeted populations, in a variety of settings and offered by a variety of partners. Programmes include group activities, information and skill development, individual outreach, special events and comprehensive citywide campaigns.
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Plans
Plans ensure that city and neighbourhood planning documents and guidelines address how urban planning decisions affect residents ability to engage in physical activity; and new plans can be developed, for example, to increase walkability in a certain neighbourhood.
Infrastructure strategy
Improved or expanded infrastructure enhances opportunities for physical activity, such as changes to parklands, trails or sport facilities and other aspects of the built environment that support active living, such as cycle tracks or sidewalks.
Communication
Communication includes both internal communication with the leadership group and external communication with the public. Promotional information and mass-media campaigns to encourage physical activity are most effective when used as part of a comprehensive campaign and strategy involving multiple interventions (Box 12). There is inevitably a long list of potential activities. Tool 7 (Part 3) provides a checklist of several criteria that can be used to select which activities to pursue in both the long and short term. Planners should play special attention to interventions that will reduce inequity in physical activity in particular parts of the city and among specific groups. One way to do this is to assign responsibility to one member of the leadership group for advocating and monitoring how the active living plan and strategy improve social inclusion and reduce inequity. Box 12. About city-wide comprehensive campaigns City-wide comprehensive campaigns can influence both the behaviour of individuals and the social systems in which they live. These campaigns can also create institutional and organizational support for behaviour change goals. These campaigns typically use both mass media and direct interpersonal programmes to reach the general public and specific population groups. Mass-media messages are combined with organizational efforts directed toward schools, workplaces, health care settings and communities. Interventions are conducted in stages based on the assumption that people modify their behaviour in a process that requires different types of support at different times. They target multiple audiences, use multiple channels of communication and involve multiple partners and stakeholders. Some address more than one type of health behaviour, such as combining a campaign for physical activity and healthy eating. This approach is particularly useful if there are concerns about obesity in the population.
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Stage 2: preparing a plan pedestrians, cyclists and cars on busy streets. Provide bicycles for government staff, especially police, park employees and meter-readers, to use on neighbourhood routes. Implement traffic control measures such as severe restrictions on speed, 20 km/hour zones, adequately timed lights, clearly marked crossings, traffic-calming devices (such as speed bumps) and crossing guards at crucial intersections. Provide clear signage about road traffic patterns to help cyclists, pedestrians and drivers avoid injuries and learn to respect each others routes. Make driving more expensive. Charge high prices for parking in the city; consider using congestion charging as a means of reducing car use overall and combining it with financial transfers to improved public transport. Give priority to funding for public transport and projects such as sidewalks, trails, traffic-calming measures and bike lanes. Park-and-ride schemes should only be used in low-density areas where existing levels of public transport are inadequate. Locate them as close as possible to the source of the traveller: for example, in outlying community sectors rather than the edge of the city. Encourage cyclists and walkers to use them as well.
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Box 13. Pay attention to special population groups Ensure that children and young people have safe places to play. Make some city streets active leisure zones suitable for childrens play and ensure that housing developments incorporate shared play areas in common spaces. Provide interesting, safe, well-maintained playgrounds, wading pools, outdoor skating rinks, skateboard parks, sport fields and cycling paths that children and young people can use. Encourage active socialization for older adults. Improve walkability, especially in areas where older people live: provide well-maintained sidewalks, benches for resting, adequate lighting and shaded and attractive streetscapes. Encourage the development of places for socialization on city streets, such as coffee shops and small markets. Provide spaces for older people to be active in local parks and green spaces with activities such as tai chi, bocce ball or ptanque, crocket, dog walking and organized group walks. In cities in cold climates, ensure that sidewalks are clear of ice in winter. Increase access to active spaces. Put playgrounds, sporting areas, trails and parks within walking or wheeling distance. Provide free or subsidized access to swimming pools and other facilities to children and youth, older adults and people with disabilities. Improve accessibility to public transport and/or provide transport to recreation facilities for people with disabilities, older adults and families in disadvantaged circumstances. Ensure that residential settings for all income groups have full opportunities for health-promoting transport and equal access to green spaces. Set targets for achieving this.
Stage 2: preparing a plan Celebrate multiculturalism and diversity. Identify and work with various cultures and religions in the community to promote appropriate physical recreation and active living opportunities and to find the best solutions for overcoming common barriers.
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Active schools
Communities and schools from preschools to colleges and universities are important partners in promoting physical activity. Through physical education and health programmes, schools provide instruction for skill development and educate young people about healthy, active lifestyle choices. Children and adolescents attend school most of the days of the week; the journey to and from school can be an important part of a physical activity regimen. Schools can also play an important role in a broader city strategy by creating supportive social networks for children, young people and families; providing a facility for community sport programmes and events; and building awareness and
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A healthy city is an active city: a physical activity planning guide knowledge about physical activity. Secondary school students can serve as role models and coaches for younger children, and universities can assist the community by developing and evaluating special programmes in collaboration with the community. Tool 5 (Part 3) provides a sample report card on how well a school or group of schools is doing in promoting physical activity. Chapter 8 provides information on where to get resources related to active schools and active, safe routes to and from school.
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Active workplaces
Because most adults spend about eight hours or more each day at work plus commuting, worksite and employer- or union-sponsored programmes to promote and enable physical activity can be an important part of an active living strategy. Workplaces can affect the health and fitness of their employees by providing supportive policies and environments, access to facilities, health promotion information and incentives for active travel to and from work. Ideally, these efforts benefit both the employer and employees: the worker gains improved health and increased energy; the employer gains a more productive and healthier workforce, reduced absenteeism and disability days, an improved corporate image and more-satisfied employees.
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Active neighbourhoods
Neighbourhoods are defined by factors in the physical, social and political environments such as electoral districts, walkability to various settings and destinations, catchments for schools and health care facilities and the cultural characteristics of a population in a given area. Families and individuals socialize in and spend much of their time in their neighbourhood.
Stage 2: preparing a plan people increasingly tend to participate in more individual activities, such as swimming for exercise or going to an exercise facility.
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Box 14. A key priority: reducing inequity in physical activity Disadvantaged populations (especially those with low incomes) are less likely to be able to afford or have access to a gym; user fees may prohibit low-income families from participating in recreation programmes and sports. Disadvantaged populations are less likely to have easy access to the places that encourage an active lifestyle, such as safe streets and sidewalks, parks, trails and community gardens. When they do choose to be active, they often face disproportionate risks related to road safety and the real or perceived risk of crime. Neighbourhood renewal schemes that provide facilities and equipment for active living (such as basketball courts, skateboarding parks, playgrounds and soccer fields), safe routes to school and to public transport stations and establishing safe neighbourhood parks can reduce inequity in access and choices for physical activity. Programmes that are culturally sensitive can draw in women, young people in minority populations and other groups that are often excluded from mainstream sport and physical activity programmes. Accessibility and integration are key to enabling people with disabilities to enjoy enhanced levels of participation.
Stage 2: preparing a plan concerns about road safety (especially older people and parents in relation to their children); concerns about personal security and crime (especially girls and women and parents of young children); unattractive environment for walking: litter, graffiti, air pollution, broken sidewalks, no resting spots or shade, etc. (especially women); no space of our own to do the things we like to do (especially young people); ageism (too old to be active), sexism (not appropriate for girls and women) and cultural restrictions; and weather conditions such as extreme heat or cold and icy conditions (especially older people). Helping people overcome these barriers requires a combination of environmental approaches and individual change strategies. Here are some ideas for increasing personal motivation for active living. Box 15. Essentials for changing behaviour among inactive populations Leading behavioural scientists suggest the following points to be essential elements for behaviour change among inactive populations. 1. They must believe that the benefits of being active (improved health, more energy, social time with friends etc.) outweigh the disadvantages (cost and time). 2. Performing the behaviour must be consistent with their self-image and not violate personal standards or values: that is, they must see perceive more social acceptance and pressure to perform the behaviour than not to do it. 3. They must have the skills necessary to perform the behaviour. 4. They must be ready to change: that is, have a strong commitment and intention to follow through. 5. Their self-efficacy must be high: that is, they believe they are capable of performing the behaviour. 6. Their environment must be free of constraints that make being active difficult or impossible and provide social support and opportunities to be active in a variety of settings. Experts in a consensus workshop saw all of these as important factors but identified three 3, 4 and 6 as essential and sufficient for this behaviour change to occur (26).
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Make the message relevant to your target audience by linking physical activity to values and issues that they are concerned with and by appealing to their level of readiness for change. Choose spokespeople and role models that your audience respects. Use competitive but fun challenges between cities, businesses, schools, neighbourhoods, etc. Encourage small steps to success and build skill development and self-efficacy into your programmes and messages. Provide opportunities to sample new behaviour with special events and incentives such as a free paddle boat ride or a mass street dance. Encourage people to enter into contracts for success, monitor their progress and reward themselves as they become more active and fit. Set up buddy systems and informal groups for physical activity, such as stroller walking on set days and times for young mothers with infants.
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A guide for population-based approaches to increasing levels of physical activity: implementation of the WHO Global Strategy on Diet, Physical Activity and Health (27) In the final stages you take a look at timing issues, implement activities in stages, measure your success and make changes to better realize your vision and objectives. You also share your results both within your city and with colleagues in other cities so that we can learn from each other.
Stage 3 Implementing the plan and measuring success 1. Stage implementation 2. Evaluate your progress 3. Share your results 4. Review and update your plan
Stage implementation
Some promising strategies to increase physical activity can be achieved quickly; others require a longer-term commitment. For example, a community might seek to improve physical activity fairly quickly, by making intersections safer so children can walk to school. A community could focus on improving physical activity in the long term by advocating for changes in urban design or for public investments in parks or recreational facilities. Some projects may be completed in the current year; others will take a number of years to complete. Strategies are more successful when they incorporate both short- and long-term activities. Take advantage of existing resources and enthusiasm to show results quickly when appropriate but ensure that sustainable resources and leadership are built in for larger-scale infrastructure and policy changes. Building an identity for your strategy takes time: protect and share it with responsible partners and use social marketing techniques to increase public recognition of your strategy and plan. Starting at home by implementing activities, policies and programmes in government offices and the sites of other key stakeholders is always a good idea. It demonstrates commitment and leadership, and allows some experimentation with ideas in friendly settings (Box 16).
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Box 16. Elements of successful programme and policy implementation In 2002, at a joint Consultation on Physical Activity Policy between WHO and the United States Centers for Disease Control and Prevention, participants developed a policy framework for physical activity. In terms of implementation, the following elements were identified as necessary for success: consultation and needs assessment; written plan and objectives; surveillance of physical activity patterns, policy, public opinion and environments; stable base of support; clear programme identity and message; coalitions, partnerships, leaders and champions and intersectoral action; multiple intervention strategies, sites, populations at all levels; integration of physical activity efforts with overall noncommunicable disease prevention and with the policies of related sectors; focus on physical activity providing enjoyment and social interaction; and evaluation throughout the process.
Source: Shephard et al. (26).
Stage 3: implementing the plan and measuring success the perceptions of community leaders and residents of all ages of the plan and its effects, which may be especially important to stakeholders, funders and elected officials. Box 17. Types of evaluation There are four main types of evaluation. Formative evaluation Formative evaluation focuses on activities that are in the planning stages to ensure that they are based on stakeholders needs and using effective and appropriate materials and procedures. Formative evaluation includes such things as: needs assessment, programme logic models, pretesting communication materials and audience analysis. Process evaluation Process evaluation focuses on activities that are already underway. They examine the procedures and tasks involved in implementing the strategy. They seek to answer the question, What services, activities and interventions are actually being delivered and to whom?. Process evaluation includes such things as tracking the quantity and description of people who are reached and tracking the quantity, quality and types of services and interventions provided. It also includes assessing how communication channels are working and funding for developing and implementing the plan. Summative evaluation Summative evaluation focuses on activities that are already underway or completed. They can include changes in attitudes, knowledge or behaviour, changes in morbidity or mortality rates, number of people participating or served, costbenefit analysis and costeffectiveness analysis. Summative evaluation investigates the effects of the activity, both intended and unintended. Impact evaluation asks Did the activity make a difference?; and outcome evaluation asks Did the activity meet its stated goals and objectives?. Outcome evaluation Outcome evaluation can assess both short-term outcomes (immediate changes in individuals or participants, such as participation rates, awareness, knowledge or behaviour) and long-term outcomes, which look at the larger impacts of a programme or policy on a community. Outcome evaluation can also analyse the results in relation to the costs of the programme.
Source: Van Marris & King (28).
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Part 3. Resources
7. Tools
Tool 1. Identifying potential partners for a physical activity task force or leadership group
Sector Health Recreation Sport Education Urban planning Transport Business Special groups Elected officials Housing or residents committees Other
Source: adapted from Community physical activity planning: a resource manual (16).
Possible contribution
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Tools
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Observational indicators Presence of sidewalks (on what proportion of streets?) Maintenance of sidewalks Presence of cycling paths or lanes on main streets Presence of separate cycling or pedestrian trails Labelling and maintenance of paths and trails Presence of city bicycles free of user charges Presence of adequate, secure parking areas for bicycles Presence of areas for walking dogs and appropriate signage
Examples of related questions that could be asked Do you have sidewalks in your neighbourhood? If yes, are they well maintained? Are there specific cycling paths or lanes at the side of the streets? Do you have access to cycling or walking trails? If yes, are they well maintained? What makes it easier for you to walk and/or cycle? What prevents you from walking or cycling more? Do you walk a dog? If yes, where do you go with your dog? Are there good routes for walking dogs and places to play with your dog? Can you get to school or work by walking or cycling or a combination of walking or cycling and public transport? Do you engage in physical activity with family members, friends and/or neighbours in your community? If yes, where do you go and when? What prevents you from being more physically active with family members, friends and/or neighbours? Do you often see people out and about in your neighbourhood? Do you feel comfortable talking with people you meet while out for a walk?
Number of people walking around the community at various times of the day and various days Number of people at various facilities and locations (such as recreation centres, sport facilities, parks and schools) at various times of the day and various days
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Observational indicators Speed of motorized road traffic at different times of the day Presence of crosswalks, pedestrian signals and traffic-calming practices Lighting at various times of the day (trails, sidewalks, schools, recreation centres, etc.) Number of reported injuries and collisions with pedestrians and cyclists Number of reported crimes in neighbourhood Number of reported attacks and injuries by unleashed dogs Presence of a community police force Presence of neighbourhood watch programmes
Examples of related questions that could be asked Do you feel safe walking in your neighbourhood? Walking to work or school? Please explain why or why not. Do you feel safe cycling in your neighbourhood? Cycling to work or school? Please explain why or why not. How would you improve safety in your area so that people could walk and cycle more?
Presence of accessible routes to waterfronts and surrounding forests, rivers, hills etc.
Do you go to surrounding areas such as lakes, seashores, forests and ski hills on the periphery of the city? If no, why not? If yes, how often do you go? How do you get there? Are there safe and interesting places for your children and adolescents to play and be active? If yes, where do they go? How do they get there? What prevents children and adolescents from being more active in your community? If you are older, are there opportunities for you to be active in your community? What prevents older people from being more active in your community? If you have disabilities, are there opportunities for you to be active in your community? What prevents people with disabilities from being more active in your community?
Presence of accessible, active spaces and social support for children and young people Opportunities for active socialization by older people Presence of accessible, active spaces and social support for people with disabilities
Tools
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Did you have room to walk? Some common problems: Sidewalks or paths started and stopped Sidewalks were broken or cracked Sidewalks were blocked with poles, signs, dumpsters, etc. No sidewalks, paths, or shoulders Was it easy to cross streets? Some common problems: Road was too wide Traffic signals too long or did not give enough time to cross Needed crosswalks or traffic signals Parked cars blocked our view of traffic Needed kerb ramps or ramps needed repair Dead-end streets with no connections to destination Did drivers behave well? Some common problems: Backed out of driveways without looking Did not yield to people crossing the street Turned into people crossing the street Drove too fast Drove through stop signs or traffic lights Was the walk pleasant? Some common problems: Needed more grass, flowers or trees Not well lit Dirty, lots of litter, run-down houses or vacant lots Dirty air due to automobile exhaust Fear of crime or attacks Loose dogs or other threats Overall walkability score (total points) 1620 Pretty good for walking. 1115 Okay, but it needs work. 510 It needs a great deal of work.
Source: adapted from Walkability checklist (30).
Rating: _____
Rating: _____
Rating: _____
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Tools Overall rating as a safe place to ride: (circle one) 1 2 3 awful many problems some problems 2. How was the surface on which you rode? Good, some problems. The road or path had: Potholes Cracked or uneven pavement Debris (such as broken glass, litter, gravel, etc.) Dangerous drain grates or utility covers Other problems: _______________________ Overall surface rating: (circle one) 1 2 awful many problems
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4 very good
5 good
6 excellent
3 some problems
4 very good
5 good
6 excellent
3. How were the intersections through which you rode? Good, some problems: Had to wait too long to cross Couldnt see crossing traffic Signal did not give me enough time to cross Unsure where or how to ride through intersection Other problems: _______________________ Overall intersection rating: (circle one) 1 2 3 awful many problems some problems
4 very good
5 good
6 excellent
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A healthy city is an active city: a physical activity planning guide 4. Did drivers behave well? Yes, some problems. Drivers: Drove too fast Passed too close Did not signal Harassed me Cut me off Ran red lights or stop signs Other problems: _______________________ Overall driver rating: (circle one) 1 2 awful many problems
3 some problems
4 very good
5 good
6 excellent
5. Was it easy for you to use your bicycle? Yes, some problems: No maps, signs, or road markings for cyclists No secure place to leave my bicycle No way to take my bicycle with me on the bus or train Scary dogs Hard to find a direct route I liked Route was too hilly Other problems: _______________________ Overall rating of ease of use: (circle one) 1 2 3 awful many problems some problems
4 very good
5 good
6 excellent
How does your community rate? Add up your ratings and decide.
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Total _____
2630 You live in a bicycle-friendly community. 2125 Your community is pretty good, but there is room for improvement. 1620 Conditions for riding are okay, but plenty of opportunity for improvements. 1115 Conditions are poor and you deserve better! Call the city now. 510 Oh dear. Consider wearing body armour before venturing out again.
Source: adapted from Bikability checklist (31).
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Tool 5. How well are our schools doing? A sample report card for physical activity
Grading scale: yes = excellent; yes but = okay but could be improved; no = failure 1. Physical education Does the school provide high-quality daily physical education classes for all students? Does the physical education programme encourage participation of all students in each class, regardless of ability? Is there an emphasis on enjoyment, safety, success, fair play, skill development, mastery of lifelong activities and personal health? Are the teachers responsible for teaching physical education qualified to teach the subject? Do the students look forward to physical education classes? Overall grade: _______ 2. Physical activity during and after school hours Does the school have standards and policies to ensure safe, supervised, active and enjoyable outdoor and indoor play on a daily basis? Does the school support and resource extracurricular sports, activities and clubs? Is planning for physical activity part of broader programmes for health-promoting schools? Are school facilities available for active recreation and sports after hours at no cost to community residents and clubs? Does the school share facilities to enable children and young people to participate in activities such as swimming and tennis? Does the school have policies prohibiting the withdrawal of physical activity as a form of punishment? Overall grade: _______
Tools 3. Active transport to and from school Does the school support and encourage walking and cycling to and from school in collaboraion with parents, the police and local agencies, such as safe routes to school programmes or walking school bus programmes? Does the school have policies discouraging parents from driving their children to school and protecting the safety of cyclists and pedestrians, such as no-idling zones, traffic-calming measures, crossing guards and pedestrian walkways? Does the school have safe, secure parking facilities for bicycles? Overall grade: _______
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4. Family involvement
Are parents and other family members involved in physical activity programmes and sports at their childrens school? Does the school communicate with parents about the value of physical activity both at school and in the home environment? Does the school communicate with parents about monitoring and restricting the amount of screen time (television, computer games, videos etc.) at home and the need to encourage active play after school hours? Overall grade: _______
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Tools
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Box 18. Le parkour: the art of movement in the urban environment Le parkour is a new urban sport that began in a poor neighbourhood in the suburbs of Paris and is spreading quickly among cities all over Europe and the rest of the world. Le parkour consists of finding new physical ways to traverse the city landscape scaling walls and trees, roof-running, balancing on existing structures and leaping from building to building. Described by urban acrobats as the art of movement and even a philosophy, le parkour is a way of using the obstacles found in ones path to perform jumps and acrobatics that combine speed, fluidity, aesthetics and originality. Beginners are advised to practice daily, not to start with high walls, to work in groups and above all not to be dared to go too far. For converts, it demonstrates the classic human urge for freedom and expression within the built environment of modern cities. indoor events: mall walking, physical activity fairs and open houses in sport and recreation facilities; dance instruction and dances on outdoor tennis courts and in indoor facilities; family picnic days with activities for all ages; muggle quiddich (inspired by Harry Potter) and other activities from fantasy and/or historical stories; and zany events linked to traditions or special days: Finland (and the Finnish diaspora) has an annual wife-carrying race in which the International Wife Carrying Competition Rules Committee mandates that all participants must have fun.
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A healthy city is an active city: a physical activity planning guide European Mobility Week (mid-September) is a week-long series of activities contributing to converting from private cars to sustainable and active modes of transport (http://www.mobilityweek.eu). Car-Free Day is part of the European Mobility Week. Many cities restrict private car use and offer a variety of activities on this day. International Walk to School Month (October) gives children, parents, schoolteachers and community leaders an opportunity to be part of a global event as they celebrate the many benefits of walking. In 2008, millions of people in 40 countries walked to school together (http://www.iwalktoschool.org). The Global Embrace consists of a chain of locally organized intergenerational walks and celebrations encircling the globe during a 24-hour period on the International Day of Older Persons, 1 October. The International Day of Disabled Persons (3 December) provides an opportunity to focus on physical activity and people with disabilities (http://www.un.org/esa/socdev/enable/disiddp.htm).
Tools
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1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4
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Barcelona, Spain
Shape Up Programme to prevent obesity in city schools Green spaces for physical activity Reducing obesity among children Support for youth-at-risk and children in ethnic minority neighbourhoods
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Intervention or theme Comprehensive plans Cycling demonstration town: personal travel advisers
Key points Active Living Strategy and Action Plan and City Sports Strategy and Action Plan (2006) In 2005, Brighton & Hove was one of six English towns and cities designated as a cycling demonstration town. A comprehensive bid secured 1.5 million from the central government Department of Transport, which has been more than matched by the City Council. To achieve a 5% increase in cyclists each year, personal travel advisers and other staff intensively support more than 75 individuals each year to become regular bike users. They also work with schools and businesses to promote cycling as a preferred mode of transport. New cycle infrastructure in the local area enables its greater use as a choice of transport. Through the personal travel adviser work, the cycling demonstration town team has demonstrated fewer car trips and more cycle trips (2008) Upgrading areas into parks for culture, leisure, recreation and sport (the largest is Merinos Cultural Park). Emphasis on preserving and planting trees (known as a city of trees) and integration with the inner city (2006) Annual sport and healthy living tournament for staff in the Metropolitan Municipality of Bursa; integration of activities for people with mental disabilities into Cultural Park and Sports Festival and Youth and Sports festival with more than 3000 participants (2006) The municipal sports club has activities in 10 sports and summer sport schools. The club operates in collaboration with schools and families (2006) The programme of regular, brisk, short walks aims to improve health by promoting regular walking, particularly targeting sedentary and disadvantaged people. Trained volunteers lead weekly walks in local places of interest and parks. A co-coordinator is employed part-time to develop and promote the scheme, which is grant funded. In 2007, more than 600 walks were held. Evaluation found that 64% of respondents walk every week, and 66% reported notable improvements in general fitness and well-being (20012007)
Bursa, Turkey
Special events
Sport development
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Key points Copenhagen on the Move is a multifaceted long-term programme designed to increase citizens participation in physical activity (2006) Comprehensive support for cycling including well-designed cycling tracks and trails, traffic-calming, city bicycles, promotion programmes, cycling workshops, etc. (ongoing) Rehabilitation focusing on healthy lifestyles including physical activity: cooperation between the City, hospitals and general practitioners (2008) City divided into 24 active zones each with a trainer to teach children who do not usually participate in sports in a variety of sports they identify as ones in which they would like to participate. In 2007, there were 5500 participants and 80 tournaments (2008) More than 40 000 women participate each year in a 10-km Womens Mini Marathon sponsored by the Evening Herald newspaper. The annual Senior Games Festival helps older people meet others and try a new activity and encourages strong social connections between towns throughout Ireland (2006) The Sports Formula programme employs and trains about 20 people to bring non-competitive recreational activities to schoolchildren. The Rainbow Walking Challenge encourages older people to take up walking and then improve their fitness by moving through the colours (2006) Mum, Dad, Lets Move Together aims to increase by 25% the numbers of children 06 years old and their parents, who actively play together. The campaign includes assessment surveys, training of concerned professionals, provision of equipment, an education campaign and special events (2008) Extended and upgraded the city promenade, which runs through a varied landscape and various historical parts of the city. Maps and information provided (2006)
Rehabilitation and wellness for citizens with chronic diseases Dimitrovgrad, Russian Federation Sports for children in local neighbourhoods
Dublin, Ireland
Helsingborg, Sweden
Pedestrian-friendly environments
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Key points The programme and policy provides disadvantaged children and youth with opportunities to be active by helping with the cost of fees, memberships and transport. Cooperation with youth groups, schools, institutions and sport clubs (2008) Some 900 local seniors participated in open physical activity and sporting events as well as delegations from 15 other towns. Cooperation with local associations and the development of a team of volunteers were critical (2008) Activities to support healthy aging and physical activity organized around the International Day of Older Persons (2006) Programme to draw disabled children and youth into sports (football) (2008) Annual Elderly Sports Day organized by the municipality and JDC-ESHEL, the Association for the Planning and Development of Services for the Aged in Israel (2006) Morning exercise and walking programmes for older people; exercise programmes in kindergartens; provision of fitness equipment stations in local parks; a well-equipped fitness centre for municipal staff to use (2006) Municipal sports club and summer sport schools (2006) Active child and youth project involving education, cultural and recreational Services and research at Kuopio University. Fitness Track works with schools, teachers and students (2008) Since 2002, several physical activity facilities have been built or renovated, including an active health park, football grounds, playgrounds, swimming pools, walking trails and cycling paths (2006) The city government provides per capita payments to sports clubs and training groups that actively engage children and youth (2006)
Sports and physical activity for disabled children Jerusalem, Israel Special event sport for older people Enabling physical activity for special groups
Kadiky, Turkey
Kuressare, Estonia
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Key points Half-day walks on Saturdays for children and their parents, visiting local sites of historical interest and linking health and educational objectives. The walks are kept fun through treasure hunts, competitions and challenges. A good alternative to walking to school, since 40% of students are from nearby villages and many travel to school by bus (2006) A partnership of local regeneration agencies turned a local grot-spot into a much-needed sports facility called Admiral Park. Local schoolchildren were included in the planning (2006) The Sport and Physical Activity Alliance is the strategic arm of Active City. In the past year, 151 000 people participated in Active City (2008) A total of 231 women from 16 ethnic backgrounds across different areas in Liverpool completed a survey, and 17 partook in focus groups with the help of community volunteers, many of whom were bilingual or multilingual. A resulting community intervention has been designed to accommodate the factors identified influencing the physical activity levels of women from diverse cultures (2008) A strategy developed by the Obesity Task Force that builds on the work already underway within the City including the many physical activity projects that are supported through the Liverpool Active City Campaign and the innovative food initiatives as a part of Taste for Health. There is the Healthy Schools Programme and the Healthy Schools Bus Initiative. The Healthy Schools Bus is fitted out with a treadmill and other fitness equipment. There is also a lesson about nutrition (with fruit tasting) and a sports and multi-skills session in school (2008) Liverpools NHS personal health trainers are a new and dynamic team (of 19) recruited from, based in and working across Liverpool communities, supporting individuals in making healthier lifestyle choices (2008)
A comprehensive programme and policy Encouraging women from diverse ethnic backgrounds
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Key points The city provides funds to nongovernmental organizations that organize physical activities for their members, such as the association for people with heart disease. The City Agency for Sport provides sport activities in kindergartens, elementary and secondary schools, and during holidays, as well as competitions, races and annual events such as the city marathon. Swimming is emphasized in elementary schools: more than 90% of all children learn to swim (2006) Through Physical Activity to Health targets preschool and school-aged children, adults and older people. Includes education, counselling and activity programmes for groups with and without obesity (2006) One example of charging cars to enter a zone in the centre of the city. Although the primary objective was to reduce traffic congestion, cycle journeys have increased by 20% with a 7% reduction in crashes. There may also have been an increase in journeys walked both as trips but also as part of the increased number of journeys on public transport (ongoing) The Quadrille Dance Festival started in Maribor to increase participation in physical activity among youth and to promote the tradition of dance. In the following years, many other cities joined in. The event was entered into the Guinness Book of Records when 23 628 dancers performed the same dance with the same music at the same time all over central Europe (2006) Programme within public health capacity-building offering educational information and sport and recreation programmes through collaboration with others including health and sport professionals and volunteers. Involved mass media, politicians, institutions, nongovernmental organizations and private sponsors (20052007) Educational classes for students, their parents and school employees about healthy diet and adequate physical activity. Measurement of body mass index among individuals in the programme (2008)
Ldz, Poland
Improving health through physical activity and proper diet Traffic congestion charge
Maribor, Slovenia
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Key points The Parks Project aims to prevent violence and antisocial behaviour in public parks and to build cycling and walking paths in the large parks. A green belt around the city connects the parks and allows green corridors to the inner city (2006) Urban planners designing public housing settlements that promote active living (2006) The annual Stramilano is a non-competitive march that twins cities around the world and involves thousands of participants, including children. Several voluntary organizations hold popular events that support the creation of new cycling paths and green corridors (2006) Milan is a leader in the all-Europe Day of Dance and the use of dance among people with disabilities and older people and disadvantaged children (ongoing) The Year of Exercise and Sport (YES) project focused on grassroots initiatives along with high-profile elite events to inspire residents. A project of the City Council supported by partners in all sectors (2006) Card entitles those aged 518 years to free activities at leisure centres, pools and local facilities. More than 7000 cards have been issued, with wide distribution in a variety of neighbourhoods. A comprehensive evaluation is underway (2008) Novocheboksarsk is called the most athletic town in Chuvashia. There are 126 600 citizens, 22% of whom are actively engaged in physical culture and sports. To support this, there are 304 sports facilities in the town: 12 swimming pools, including the only 50-metre pool in Chuvashia and in the Volga region, a city stadium with 8000 seats, 45 sport halls, 115 sports fields, 13 shooting galleries, 10 ice hockey rinks, 15 sports clubs, a 200-metre track-and-field arena, a lighted ski track, a skiing base, an ice palace and a sports complex that is unique in the Volga region
Comprehensive programme of sports, exercise and physical activities for all ages Fusion card
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Key points Between 1999 and 2002, 50 projects to promote and enable cycling were implemented, including physical improvements, changes in regulations and campaigns, with an emphasis on trying out innovative ideas. By the end of 2002, cycling traffic had increased by 20%, and the number of accidents involving cyclists had been reduced by 20% compared with 19961997. The project resulted in great savings for the health sector, largely attributed to increased safety and to a reduction in noncommunicable diseases (ongoing) Aquamagic provides attendance free of charge for water sport activities for all interested teachers in kindergartens, primary and secondary schools. The idea is that teachers serve as role models and will inspire their students to take up water sports (2006) A pilot project on how changing the school environment can promote physical activity and healthy eating and prevent obesity. Three schools participating in Pcs for three years (2008) City offers universal swimming lessons and courses in skiing, skating and snowboarding and co-funds recreation centres and sports leagues. Many thousands of children participate (2008) Poznan schools are participating in this three-year project to change school environments to promote physical activity and healthy eating and prevent obesity (2008) Free, supervised and adapted exercise programmes for citizens older than 50 years. The number of participants continues to grow (2008) The City Council worked with school authorities and parents, the police, district representatives and road safety officers. Each walking school bus has an adult driver in the front and at the rear. In 2005, more than 50 schools (1300 children and 100 bus lines) were involved. In 20062007, the programme will be extended to all school districts (2006)
Pcs, Hungary
Shape Up Project school-based, regional and Europe-wide Poznan, Poland Programmes for children
Shape Up Europe
Rijeka, Croatia
Healthy, active ageing for people 50 years and older Walking School Bus
Rome, Italy
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Key points This programme informs people about the benefits of walking and provides group walks, including ones with an expert on bird-watching (2006) An integrated set of actions to decrease car use and enable more active and environmentally friendly transport. Includes reduced speed limits, construction of pedestrian areas, underground parking spaces and a network of protected cycle-ways and improvements in public transport (2006) One week in September is dedicated to a sustainable mobility week including Car Free Day on 22 September. In 2006, activities included closing the town centre to private cars, a non-competitive cycling ride, an international conference, the installation of 14 new bicycle parking sites, repair workshops for childrens bikes, and the creation of a mobility panel with various committees working on pedestrian mobility, the elimination of barriers, cycling, public transport, etc. (2006) Comprehensive programme to encourage cycling including about 70 km of cycle lanes, 400 parking stands and free city bikes. After 10 years, cycle traffic has increased by about 10% and now represents 5% of the overall road traffic in winter and 12% in warmer seasons (ongoing) Children identify and register play areas, shortcuts and reference areas for schools and nurseries. These must be used in all planning activities to safeguard important play areas (2006) Do you want to play with us? offers physical activity close to home to children 612 years old: 60 minutes of active games led by an instructor in open-air municipal areas marked by a common logo (2008) Seven local governments in Estonia and seven in Finland are participating in collaboration to enable local governments to improve opportunities for physical activity and encourage cooperation between sectors and governments at the national and international levels. Includes a survey, cooperative training and workshops and special events (2006)
Sandnes, Norway
Cycling City
Involving children in landuse planning: the Childrens Trail Programme Sant Andreu de la Barca, Spain Active living against obesity
South FinlandEstonia
Cross-border cooperation
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Key points For almost 10 years, the municipality has been offering free walking tours led by trained volunteers. The walking groups primarily attract women aged 55 years and older; many have never exercised before. Participants find walking in groups to be sociable, safe and stimulating (ongoing) The Stirling Physical Activity Task Group is a unique partnership with representatives from voluntary organizations, environment, transport, public health, health promotion, primary care, Active Stirling and childrens services. This has resulted in more efficient use of resources and some innovative initiatives, including midnight football, twilight basketball, free swimming for those younger than 16 years of age, music and dance activities and workplacebased initiatives. Long-range urban design plans include shifting road traffic flow, supporting safe active routes to schools and safer play areas and regenerating several rundown sites (2006) The Go5 Project helps people with lower socioeconomic status become more physically active. Primary health care professionals refer clients to a 10-week programme offering up to five activities per week: gym visits, swimming and led walks for a maximum of 10 (2006) Closing the Gap assists sporting groups to better engage with non-traditional partners and work effectively with young people who are experiencing or are at risk of social exclusion (2006) Lifestyle programme for high-risk individuals, who are offered an intensive lifestyle support programme including counselling and group-based sessions in physical activity, weight management and positive thinking. A robust evaluation is underway (2008)
Reducing inequity
Community wellness programme for disadvantaged populations Exercise referral for prevention and management of chronic disease
Provides opportunities for physical activity in the heart of the community (eight sites) with trained staff and volunteers; 2000 users in the first nine months Physicians refer high-risk people and those with chronic illnesses to the City wellness programme. Each year more than 1500 individuals complete the 15-week programme
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Key points Motion 2000 included a wide range of communication activities, services, counselling and the involvement of city planners in making changes in the built environment. Between 1993 and 2004, the percentage of active adult city residents increased from 28% to 42%. The development and implementation of a comprehensive strategy continues and is described in Active living in Turku promoting health by means of physical activity (32) The Gym at Home! Programme includes leaflets and television exercise programmes that older people can do at home. Uses volunteer peer instructors. Cooperation between local nongovernmental organizations and health care and sports services Ladies and Gentlemen against Back Pain is a cooperative project designed to enable older citizens to prevent back pain and improve posture. Three-month exercise course free of charge (2008) Regional healthy city project includes promoting healthy eating and creating walking groups who meet 23 times per week The aim of this project is to verify the effect of multidisciplinary intervention programmes (nutrition, physical activity and leisure time) on the prevalence of obesity among children 310 years old. Evaluating and characterizing the eating habits in these children, the activities during leisure time, verifying the conditions of the equipment schoolyard and activities during free time in the schoolyard and the levels of physical condition through the classes of physical education. This project will be implemented during four years and will include a nutritionist, physical education teachers, parents, teachers, counsellors and specialists in different types of equipment for playgrounds and schoolyards to promote active lifelong behaviour (20082011)
Udine, Italy
Adding life to old age: a regional programme involving 15 municipalities Vila Real, Portugal Active schools, growing healthy
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A healthy city is an active city: a physical activity planning guide European network for the promotion of health-enhancing physical activity (HEPA Europe) (http://www.euro.who.int/hepa). The vision of the network is to achieve better health through physical activity among all people in Europe. Green Map System (http://www.greenmap.com). Green Maps are locally created maps that chart the natural and cultural environment using adaptable tools and a shared visual language of Green Map Icons to highlight green living resources. International Association of Public Transport (http://www.uitp.com). A worldwide network of public transport professionals. Reports and a city mobility database are available. International Council on Active Aging (http://www.icaa.cc). Information and educational resources to promote active living and wellness with age. Healthy Kids Tool Kit (http://www.healthytoolkit.ca/home). Public Health Agency of Canada. Tips, activities, lesson ideas, research and promotional ideas on healthy eating, active living, physical education and healthy relationships. National Institute for Health and Clinical Excellence: public health intervention guidance on physical activity (http://www.nice.org.uk/PHI002). Four commonly used methods to increase physical activity. ParticipACTION Archives (http://www.usask.ca/archives/participaction). An archive of social marketing examples and articles about the worlds longest running and most successful physical activity social marketing campaign. Paths for All Partnerships (http://www.pathsforall.org.uk). Learn from 19 diverse organizations in Scotland who have partnered to create a network of paths for walkers, cyclists and horse riders of all ages and abilities. Pedestrian and Bicycle Information Centre (http://www.pedbikeinfo.org). A clearinghouse for information about pedestrian and cycling issues, resources and links. Saskatoon in Motion (http://www.in-motion.ca). Web site of Canadas premiere active city with links to other cities and the provincial programmes spawned by the pilot project in Saskatoon. Smart Growth (http://www.smartgrowth.org). Articles, case studies and publications on smart growth, active living and public health. South Carolina Prevention Research Center (http://prevention.sph.sc.edu). Information, electronic newsletter and electronic mailing list on physical activity.
Key sources for further information Sustrans (http://www.sustrans.org.uk). Creative, imaginative and practical community-based solutions to the transport, environmental and health challenges affecting everyone; photo library and information on guidelines, best practice and active travel, smart and safe routes to school, cycling, walking, etc. Transport, Health and Environment Pan-European Programme (http://www.thepep. org). Clearinghouse for information on sustainable public transport, including projects on walking and cycling. Wisconsin Department of Health Services (http://dhs.wisconsin.gov/health/ physicalactivity/ToolCalcs.htm). An extensive supply of tools and calculators related to physical activity and nutrition.
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Selected publications
Examples of comprehensive city plans
Active living in Turku: promoting health by means of physical activity. Turku, City of Turku, 2006 (http://www. marebalticum.org/balticoffice/images/stories/active_living/turkubook.pdf). This publication describes the 15 years of experience in building an active city that values and promotes health-enhancing physical activity. It is a practical handbook presented as a cookbook of ideas, best practices and products. More people more active more often. Municipality of Brighton & Hove, 2006 (http://www. brighton-hove.gov.uk/downloads/bhcc/713_Sports_Strategy.v4.pdf). The Brighton & Hove activity planning pack contains an active living strategy and action plan and a city sports strategy and action plan.
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A healthy city is an active city: a physical activity planning guide Edwards P Tsouros AD. Promoting physical activity and active living in urban environments: the role , of local governments. The solid facts. Copenhagen, WHO Regional Office for Europe, 2006 (http:// www.euro.who.int/document/e89498.pdf). United States Centers for Disease Control and Prevention. Promoting physical activity: a guide for community action. Champaign, IL, Human Kinetics, 1999. Barton H, Tsourou C. Shaping neighbourhoods for health, sustainability and vitality. London, Spon Press, 2000. A guide for population-based approaches to increasing levels of physical activity: implementation of the WHO Global Strategy on Diet, Physical Activity and Health. Geneva, World Health Organization, 2007 (http://www.who.int/dietphysicalactivity/PA-promotionguide-2007.pdf). Nutbeam D, Bauman A. Evaluating health promotion in a nutshell: a practical guide to the evaluation of health promotion programs. Maidenhead, McGraw-Hill Education, 2006.
Active transport
Dombois OT et al. Collaboration between the health and transport sectors in promoting physical activity: examples from European countries. Copenhagen, WHO Regional Office for Europe, 2006 (http:// www.euro.who.int/document/e90144.pdf). Designing for active transportation. San Diego, CA, Active Living Research, 2005 (http://www. activelivingresearch.org/downloads/transportationrevised021105.pdf). Cavill N et al. Economic assessment of transport infrastructure and policies: methodological guidance on the economic appraisal of health effects related to walking and cycling. Copenhagen, WHO Regional Office for Europe, 2007 (http://www.euro.who.int/Document/E90944.pdf) Racioppi F et al., eds. Physically active life through everyday transport with a special focus on children and older people and examples and approaches from Europe. Copenhagen, WHO Regional Office for Europe, 2002 (http://www.euro.who.int/document/e75662.pdf). Racioppi F et al. Preventing road traffic injury: a public health perspective for Europe. Copenhagen, WHO Regional Office for Europe, 2004 (http://www.euro.who.int/document/e82659.pdf). Dora C, Phillips M, eds. Transport, environment and health. Copenhagen, WHO Regional Office for Europe, 2000 (WHO Regional Publications, European Series, No. 89; http://www.euro.who.int/ document/e72015.pdf).
Key sources for further information Rutter H et al. Health economic assessment tool for cycling (HEAT for cycling): user guide. Copenhagen, WHO Regional Office for Europe, 2007 (http://euro.who.int/transport/policy/20070503_1). This tool estimates the economic savings resulting from reduced mortality dies to cycling, determining the economic value of declining mortality if x people cycle y distance on most days.
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A healthy city is an active city: a physical activity planning guide Promoting physical activity for children. London, National Institute for Health and Clinical Excellence, in press (http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11672). Active and safe routes to school [web site]. Peterborough, ON, Green Communities/Active & Safe Routes to School, 2008 (http://www.saferoutestoschool.ca). Resources and guides for schools and communities. Walk to school initiatives: take steps towards a better way. Chapel Hill, Pedestrian and Bicycle Information Center, University of North Carolina Highway Safety Research Center, no year (http:// www.walktoschool.org/downloads/WTSDbooklet.pdf). Useful information booklet. Active Schools plan 2004. Wellington, Sport & Recreation New Zealand, 2004 (http://www.sparc. org.nz/admin/ClientFiles/f8119e6f-65ee-4492-8c6a-7bbe8041cf35.pdf). Outlines major components of the Active Schools initiative in New Zealand. The walking school bus: coordinators guide. Wellington, Land Transport New Zealand, 2007 (http:// www.eeca.govt.nz/eeca-library/transpor t/school-travel-plans/guide/walking-school-buscoordinator-guide-07.pdf). World Health Organization and World Economic Forum. Preventing noncommunicable diseases in the workplace through diet and physical activity. WHO/World Economic Forum report of a joint event. Geneva, World Health Organization, 2008 (http://www.who.int/dietphysicalactivity/workplace/en/ index.html).
Key sources for further information Steps to health: a European framework to promote physical activity for health. Copenhagen, WHO Regional Office for Europe, 2007 (http://www.euro.who.int/Document/E90191.pdf). Kahlmeier S, Racioppi F Martin BW. HEPA Europes contributions to healthy living and move for health , in the European Region. Bulletin of the International Council of Sport Science and Physical Education, 2007, 49:48 (http://www.euro.who.int/Document/HEPAN/HEPA_ICSSPE_bull_49.pdf). 10 things you need to know about physical activity. Copenhagen, WHO Regional Office for Europe, 2007 (http://www.euro.who.int/Document/NUT/10_things_eng.pdf). Is physical activity a reality for all? Move for Health Day 2008. Copenhagen, WHO Regional Office for Europe, 2008 (http://www.euro.who.int/mediacentre/PR/2008/20080508_1).
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References
1. Edwards P Tsouros AD. Promoting physical activity and active living in urban environments: the role of local , governments. The solid facts. Copenhagen, WHO Regional Office for Europe, 2006 (http://www.euro. who.int/healthy-cities/UHT/20050806_14, accessed 7 October 2008). 2. Cavill N, Kahlmeier S, Racioppi F. Physical activity and health in Europe: evidence for action. Copenhagen, WHO Regional Office for Europe, 2006 (http://www.euro.who.int/document/e89490.pdf, accessed 7 October 2008). 3. Health Behaviour in School-aged Children (HBSC) study: international report from the 2005/2006 survey. Copenhagen, WHO Regional Office for Europe, 2008 (Health Policy for Children and Adolescents, No. 5; http://www.euro.who.int/eprise/main/WHO/InformationSources/Publications/Catalogue/20080617_1, accessed 7 October 2008). 4. Steps to health: a European framework to promote physical activity for health. Copenhagen, WHO Regional Office for Europe, 2007 (http://www.euro.who.int/Document/E90191.pdf, accessed 7 October 2008). 5. Branca F, Nikogosian H, Lobstein T. The challenge of obesity in the WHO European Region and the strategies for response. Copenhagen, WHO Regional Office for Europe, 2007 (http://www.euro.who.int/ InformationSources/Publications/Catalogue/20070914_1, accessed 7 October 2008). 6. The world health report 2002 Reducing risks, promoting healthy life. Geneva, World Health Organization, 2002 (http://www.who.int/whr/2002/en, accessed 7 October 2008). 7. Srensen J, Horsted C, Andersen LB. Modellering af potentielle sundhedskonomiske konsekvenser ved get fysisk aktivitet i den voksne befolkning [Models of the potential health economic effects of increased physical activity among the adult population]. Odense, University of Southern Denmark, 2005. 8. Juel K, Srensen J, Brnnum-Hansen H. Risk factors and public health in Denmark: summary report. Copenhagen, National Institute of Public Health, University of Southern Denmark, 2007. 9. Duhl LJ, Sanchez AK. Healthy cities and the city planning process: a background document on links between health and urban planning. Copenhagen, WHO Regional Office for Europe, 1999 (http://www.euro. who.int/document/e67843.pdf, accessed 7 October 2008). 10. Frank L, Kavage S, Liman T. Promoting public health through smart growth. Vancouver, Canada, SmartGrowthBC, 2006 (http://www.smartgrowth.bc.ca/Default.aspx?tabid=155, accessed 7 October 2008).
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